BREAKING: Physicians and ACLU sue HHS, RFK Jr. over "gender ideology" censorship in patient safety forum.
The lawsuit argues that the Trump administration violated the free speech of private citizens who had posted peer-reviewed articles on the federal government-hosted Patient Safety Network website.
We have breaking news here. I’m indebted to the dedicated attorneys who brought this information to me (and were generous with their time in explaining everything), the plaintiffs who are bravely speaking out, and the experts quoted below.
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Moments ago, two of my Harvard Medical School colleagues, backed by the American Civil Liberties Union, filed a lawsuit against Robert F. Kennedy Jr. and the US Department of Health and Human Services and Trump administration defendants which “challenge[s] the removal of their articles from the Patient Safety Network…a government-run website for doctors and medical researchers to share information about medical errors, misdiagnoses, and patient outcomes.”
The action follows a story last month by MedPage Today’s Jennifer Henderson, which reported that the HHS’s Agency for Healthcare Research and Quality had removed content that had been submitted by physicians acting as private citizens—and that those doctors had refused to make changes that would have amounted to compliance with the Trump administration’s orders to scrub all government websites of certain unfavored terms, such as “LGBTQ” or “transgender.” The defendants are the directors of the Office of Personnel Management, HHS, and the Agency for Healthcare Research and Quality (which runs the Patient Safety Network).
Unlike an earlier ruling in a case filed by Doctors for America (which required the federal government to restore removed websites the administration said promoted “gender ideology”) the new case, filed in Massachusetts, leans on a First Amendment claim. The Doctors for America victory relied on the Administrative Procedure Act (APA), which prohibits the “arbitrary and capricious” removal of content that, for example, is substantially relied upon by medical professionals. Freedom of speech was not an issue in the Doctors for America case, however, because the government indeed can determine what its own websites and employees (acting in their official capacities) may and may not say. (The current case also makes APA claims.)
Who are the plaintiffs?
The plaintiffs are two academic physicians who submitted and published educational cases on the Patient Safety Network, an HHS asset, and one of the world’s pre-eminent forums for evidence-based efforts to improve patient outcomes by decreasing medical errors via the discussion of difficult or interesting cases—a modern and public version of the long-standing tradition in hospitals known as M&M (morbidity and mortality) conference.
The way the Patient Safety Network works is that experts—like the plaintiffs Dr. Gordon Schiff and Dr. Celeste Royce—submit interesting cases to the website’s editorial board (with case details changed to protect patient privacy.) After extensive peer review, some submissions are accepted and published. The growing collection of cases is currently viewed by thousands of people per day.
The crackdown begins…
Days after President Trump’s inauguration, the Office of Personnel Management issued an executive order that, among other things, directed federal agencies to “[t]ake down all outward facing media (websites, social media accounts, etc.) that inculcate or promote gender ideology.” Shortly thereafter, Dr. Schiff and Dr. Royce received emails from an editor at the Patient Safety Network (a government contractor at UC Davis) informing them that their previously accepted cases had been removed.
In Dr. Schiff’s case, the editor informed him that a paper he had co-authored that discussed suicide risk had been removed because somewhere deep into the document, “transgender” and “LGBTQ” were listed as risk factors for suicide, among others including “male sex, veterans, Indigenous tribes…as well as more obvious populations such as those with serious mental illness, prior suicide attempts, ideation/attempts”.
Schiff had not thought about that paper for a while, he told me yesterday. “We were shocked [that] a peer-reviewed scientific article was ordered to be removed.” What’s more, “this article wasn’t advocating anything. We were just listing the risk factors,” he said. The censorship was all the more nonsensical because mental health is championed by members of Congress on both sides of the aisle. “This is not a Democrat or Republican issue. Fifty thousand people die from suicide per year. It’s very tragic,” he said.
In Dr. Royce’s case, the editor informed her that a paper she had co-authored which highlighted a case of a delayed diagnosis of endometriosis (a painful and potentially infertility-causing condition in which “cells similar to the lining of the uterus grow outside the uterus”) included a sentence reminding clinicians that the condition “can occur in trans and non-gender conforming people and lack of understanding this fact could make diagnosis in these populations even more challenging.”
Neither of these cases were promoting any type of ideology. They were simply identifying risk factors that, if not accounted for, could lead to medical errors or misdiagnosis. As an ER physician, I can attest that the assessment of transgender people carries distinct considerations. If a person who was born male is taking estrogen, at what point do they have the same risk of an abnormal blood clot as a female who takes estrogen-containing birth control pills? If a person who was born female takes testosterone, at what point do they have the same risk of early heart disease as someone who was born male? There are no clear answers but our current ignorance is a setup for misdiagnoses and medical errors. And regardless of whether you support, oppose, or are indifferent to the notion that people take gender-affirming hormone therapies, it is occurring nonetheless. As such, clinicians need as much information and insight as possible to avoid attendant medical mistakes. Papers that highlight what physicians have learned the hard way—such as those posted on the Patient Safety Network by Dr. Schiff, Dr. Royce, and many others—aim to make physicians better by raising unusual ideas that might not have been taught in school or that reflect developing bodies of knowledge. That is why the Patient Safety Network was created.
A wider pattern, a “blatant” violation.
The alleged free speech violations were not limited to Dr. Schiff and Dr. Royce. A preliminary analysis by Inside Medicine reader Polly Powledge found that at least seventeen Patient Safety Network webpages that were online in late 2024 are currently gone. Some of those pages appear to be unrelated to censorship, but enough of them seem to have been targeted due to mentions of transgender people and other so-called “woke” topics like “cultural competence” that the disappearance of these papers was clearly not random.
In fact, Dr. Schiff and Dr. Royce were explicitly told by an editor at the Patient Safety Network that their manuscripts had been removed because of their “gender ideology” content. ACLU lawyers pounced because they quickly realized the First Amendment implications of such a clear “viewpoint-based restriction in a government forum.”
Again, this was not an instance of the government choosing what it wants to say on its own behalf. “AHRQ and HHS are adamant that [Patient Safety Network] hosted content is not to be understood as representing the agencies’ own position,” the ACLU lawsuit says. The website even includes a disclaimer stating that “readers should not interpret any statement in this report as an official position of AHRQ or of the U.S. Department of Health and Human Services.”
Georgetown Law Professor Lawrence O. Gostin, who has not yet seen the complaint, said (based on hypothetical descriptions of cases similar to those in the lawsuit) that this sounded like “blatant censorship.”
“The Constitution grants the government considerable leeway to say what it wants to say, even if it is false or misleading. But the government cannot censor the speech of individuals or non-governmental entities. If the government hosts a public forum and selectively removes information it does not like that was posted by private individuals, in my view this would be classic content censorship in violation of the First Amendment. The government is preferencing certain ideas over other ideas, which it should not do.” —Professor Lawrence O. Gostin.
So, it seems as though the Trump administration up and forgot about the United States Constitution when it decided to pick and choose what content would remain on the Patient Safety Network website and what would be removed.
AHRQ: An agency under duress.
Trump administration censorship is not the only disturbing development at the Agency for Healthcare Research and Quality, according to a former member of the AHRQ executive leadership team I spoke to yesterday. “Sadly, under the Trump/Musk administration, AHRQ is being gutted,” the former HHS employee told Inside Medicine. “Good people are leaving or being forced out. Important projects have been halted or delayed; websites are being scrubbed of evidence that relates to gender, equity, diversity, inclusion, discrimination, or even women! Highly qualified skilled professionals are phobic, looking for other jobs, and no work is getting done.”
Many people have left AHRQ, the source told me. That has left few qualified people to carry out the work of the agency, which focuses on enhancing the effectiveness of health services in the United States by investing in research, creating measurement and national standards, and other activities aimed at moving knowledge from paper to practice. “AHRQ was such an important agency for healthcare,” the former employee said. “It’s a tragedy.”
Meanwhile, Dr. Schiff sees the Trump administration’s censorship as part of a broader chill in the medical and science community. “Everyone I know who is submitting grants has changed or withdrawn them,” he said. “Things are happening and they are not right. Most people are just tightening their belts, and they are not speaking out because they are fearful for their jobs.
Still, he was heartened that he was not alone in taking a principled stand against censorship. He said that authors of other Patient Safety Network manuscripts had also been offered the chance to have their papers reinstated, so long as they bent to Trump administration-approved requirements and deletions. All of them refused. Still, very few have spoken out in public—which is part of why he has chosen to do so. “It’s important for people to stand up,” he said.
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Thank you for sharing this with us. I hope that more physicians will speak out and act against this denialism. This administration is expecting you to practice medicine with one hand tied behind your back, or one eye closed.